Abstract

Objective To identify trends in emergency admissions for patients with clinical conditions classed as ‘ambulatory care sensitive’ (ACS)
and assess if reductions might be due to improvements in preventive care.

Design Observational study of routinely collected hospital admission data from March 2001 to April 2011. Admission rates were calculated
at the population level using national population estimates for area of residence.

Participants All emergency admissions to National Health Service (NHS) hospitals in England from April 2001 to March 2011 for people residents
in England.

Main outcome measures Age-standardised emergency admissions rates for each of 27 specific ACS conditions (ICD-10 codes recorded as primary or secondary
diagnoses).

Results Between April 2001 and March 2011 the number of admissions for ACS conditions increased by 40%. When ACS conditions were
defined solely on primary diagnosis, the increase was less at 35% and similar to the increase in emergency admissions for
non-ACS conditions. Age-standardised rates of emergency admission for ACS conditions had increased by 25%, and there were
notable variations by age group and by individual condition. Overall, the greatest increases were for urinary tract infection,
pyelonephritis, pneumonia, gastroenteritis and chronic obstructive pulmonary disease. There were significant reductions in
emergency admission rates for angina, perforated ulcers and pelvic inflammatory diseases but the scale of these successes
was relatively small.

Conclusions Increases in rates of emergency admissions suggest that efforts to improve the preventive management of certain clinical
conditions have failed to reduce the demand for emergency care. Tackling the demand for hospital care needs more radical approaches
than those adopted hitherto if reductions in emergency admission rates for ACS conditions overall are to be seen as a positive
outcome of for NHS.